You don’t keep the Medicare promise when you bloc grant and cut Medicaid

Paul Ryan and Mitt Romney have been campaigning on Medicare–claiming that people over 55 and current Medicare recipients will be unaffected by their proposed conversion of Medicare from a universal comprehensive defined benefit to a variously-defined premium support program.

I’m far more concerned about what Romney and Ryan’s proposals would do to low-income elderly or disabled people, especially the nine million “dual-eligibles” who rely on both Medicare and Medicaid. This is the poorest, sickest, and most complex segment of the Medicare population. These vulnerable men and women account for about one-third of Medicare’s total costs. They also seem out of sight, out of mind, in this year’s campaign debate.

Paul Ryan campaigned in Florida by visiting the Villages, a rather upscale 25,000-acre retirement location whose website brags about residents’ high incomes and the area’s 29 executive golf courses. I wish Ryan would get out of the Villages, and visit some of Florida’s 400,000 dual-eligible seniors. His proposals to bloc grant and deeply cut Medicaid would hurt this population, would hurt state governments, and would inevitably hurt Medicare, too.